Injury Codes and E-CodesWhat Are They, and How Do You Use Them?

Learn all about injury codes, E-codes, and how to use them...

As a medical coder, it's important to know the best coding practices, especially in the case of coding injuries and E-codes.

Even though these codes aren't always required by insurance, they're an important method of adding additional information to a medical claim. A good way to think of it is that every time you use an ICD-9 diagnosis code that's in the 800s or 900s, you also need to include at least one E-code on the claim.

What are injury and E-codes?

Injury codes are typically any codes that are in the 800s to 900s in the ICD-9 manual. These codes reflect diagnoses or conditions that resulted from some sort of injury, such as a fracture, wound, or bruise.

On the other hand, E-codes are used to give more information about the patient's diagnosis code.

They are most typically used to give more information about a patient's injury, but you can also use them to report more information about any type of diagnosis.

More specifically...

The description of E-codes in the ICD-9 manual is:

Supplemental Classification of External Causes of Injury and Poisoning.

In other words, use E-codes for adding supplemental information to your claims. Insurance companies and other health agencies then use this information to research and evaluate methods of preventing injuries.

There a few different types of E-codes. Each describes certain aspects of the patient's injury, including:

Activity Codes, which describe what the patient was doing when he or she was hurt

Cause of the injury

Intent, which describes whether or not the injury was intentional

The status of the individual (civilian or military)

The location where the injury event occurred

You can include more than one type of E-code on a claim to describe each and every necessary aspect of an individual's injury.

Categories of E-codes

To help you find the correct code more easily, E-codes are divided into specific categories, which group injuries by type:

Transport accidents, such as motor vehicle collisions

Poisoning and adverse effects of drugs, medicinal substances and biologicals

Accidental falls

Accidents caused by fire and flames

Accidents due to natural and environmental factors

Late effects of accidents, assaults, or self-injury

Assaults or purposely inflicted injury

Suicide or self-inflicted injury

General E-coding guidelines

There are many specific guidelines which govern the way E-codes are reported and used on medical claims.

There are more very specific guidelines than can be listed here. Generally they follow the type of medical coding guidelines as many other diagnosis codes, such as specificity and the correct selection of the first-listed diagnosis.

These guidelines include:

E-codes can never be listed as the first diagnosis

Using the full range of E-codes, as well as using as many E-codes as necessary to fully describe an accident or injury

Using the Index to External Causes in the ICD-9 manual, as in the proper selection of all ICD-9 codes

An E-code can never be a first-listed diagnosis

If two or more injuries require E-codes, code the E-code that corresponds to the most serious injury code

Use an E-code to indicate the place of occurrence

If a poisoning, do not code directly from the Table of Drugs, and code as many E-codes as necessary to completely describe the poisoning

When two or more drugs are involved in a poisoning, code for each of the drugs involved in the incident

Child and adult abuse codes must indicate whether or not the injury was intentional

Late effect E-codes are for the late effects resulting from an injury or poisoning, not from misadventures and surgical complications

There are specific E-codes for misadventures and complications of care

A lot to remember...

The above list is only a very small portion of the actual E-coding guidelines. There are more guidelines, which govern:

the way E-codes are used

how they are sequenced

and how often you can use them.

But it's important to keep in mind that you don't have to remember all of this!

When you're actually coding for a doctor's office or medical facility, you'll have your trusty ICD-9 manual in front of you at all times. You'll have all the necessary guidelines in front of you.

Mandatory E-code reporting

Some states make E-code reporting mandatory, so you need to know what you are required to do legally before deciding on whether or not to include E-codes on your claims.

In states where E-coding isn't mandatory, it's up to the doctor's office or facility whether or not include them. It's also important to remember, whether or not your office decides to report E-codes, that they do communicate important information about accidents and injuries.

The Occupational Safety and Health Administration (OSHA) and Worker's Compensation are two agencies that track the reporting of E-codes to keep an eye on the types of accidents that are occurring and the treatments that were provided.

When E-Coding is necessary

Whether or not it's legally mandated, it's always a good idea to include E-codes on accident claims. These are claims that have resulted from sort of workplace, auto, or other accident that may be covered by an insurance other than medical insurance.

Example: when completing an auto accident claim, you'll need to indicate on the claim status that the visit was due to a car accident. You'll also have to include the date of the accident and all the necessary procedures and diagnoses from the patient's visit.

On this claim, you also need to designate the type of accident (car, motorcycle, pedestrian, driver, passenger, etc). This extra information is given to the car insurance company who'll make a determination, based on the medical claim, whether or not to pay for additional injury fees.

Including E-codes on your claims is good medical coding practice. Correctly finding, sequencing, and reporting E-codes on your claims indicates your commitment to correct coding as well as your professional ability to be a great coder.